Two-year-old Quinn Hales confidently places her toy stethoscope against baby sister Finley's chest to listen to her heartbeat. It's a skill she's been honing ever since Finley was just a curiosity in mom's belly.
When the girls' mother, Sian, was pregnant with Finley, she participated in a program at Mayo Clinic called OB Nest, which seeks to improve patient satisfaction by reducing the number of prenatal appointments from anywhere between 12 and 14 to just eight for low-risk pregnancies. Expectant mothers with low risks of pregnancy complications are given home-monitoring devices for checking the baby's heart rate and the mother's blood pressure and have access to an online care community, dedicated nurses and nurse call line to answer questions between visits.
"Quinn loved it," Sian says. "Sometimes it would be days before our scheduled monitoring check, and she would ask, 'Are we going to check the baby's heartbeat today?' She would get the jelly for me and sit by me as we found the heartbeat together."
A New Model of Care
The concept for OB Nest was born out of concerns that the traditional approach to prenatal care — a fixed schedule of 12 to 14 short visits to check for a steady heartbeat and growing baby — was no longer meeting patients' needs and, in fact, was creating more burden for the patient and families than assurances.
"When we noticed patient satisfaction was declining, we wanted to find a better way to care for expecting moms," says obstetrician Abimbola O. Famuyide, M.B.B.S., chair of the Mayo Clinic Department of Obstetrics and Gynecology.
The clinical team found the help they needed in Mayo Clinic research and design groups. The Department of Obstetrics and Gynecology first partnered with service designers in the Center for Innovation, who developed and piloted several practice adaptations aimed at improving the care experience for moms.
Preliminary pilot results informed the proposed new model of care, termed OB Nest. The model was then evaluated in a clinical trial by researchers in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. This team assessed important patient outcomes and evaluated patient and staff perspectives on the new model in practice.
Results from an OB Nest's clinical trial found that women had the same quality of care as those receiving traditional care, but they had higher satisfaction and less stress and anxiety.
"This fulfills the holy grail of what patients expect today," Dr. Famuyide says. "It expands choices for women and gives them the opportunity to pick what works best for them. That improves patient experience and clinical outcomes, while at the same time keeping costs down."
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Perinatal Genomic Testing
Cell-free DNA from a mother's bloodstream can be analyzed to provide insight into the health of a fetus
After only about 10 weeks of pregnancy, DNA of the fetus can be found scattered throughout the bloodstream of the mother. Having escaped the womb to float among mom's red blood cells, these genetic snippets, called cell-free DNA, provide insight into the fetus.
New tests, created with support from the Mayo Clinic Center for Individualized Medicine, look at this genetic material to determine the risk for certain inheritable diseases. The tests provide families with a new level of information to help guide health decisions.
"Newer developments in perinatal testing are practice-changing," says Mayo Clinic obstetrician Myra J. Wick, M.D., Ph.D. Here are three tests that are now available to expectant parents.
- A cell-free DNA test examines the baby's DNA for the risk of chromosome disorders such as Down syndrome. With higher detection rates and fewer false positives, a cell-free DNA test is now used in place of more traditional first- and second trimester screening methods, especially for women who have a higher risk of these disorders. This test provides a first look at baby's development and can help guide the use of diagnostic tools.
- Expanded carrier screening takes a look at mom and dad's DNA to see if they "carry" any markers for more than 100 inherited genetic disorders. This blood test helps to identify disorders that aren't inherited uniformly. For example, if each parent carries a normal copy of a gene and an abnormal copy of the gene, a fetus could inherit two normal copies, one normal and one abnormal copy, or two abnormal copies of the gene. Carrier screening helps identify what odds a fetus faces in developing a disorder.
- Sometimes an ultrasound during pregnancy reveals problems. In cases where a more definitive diagnosis cannot be made with traditional genetic testing, a read-through of all the protein-coding parts of the DNA of the fetus may help. Called whole-exome sequencing, this test can identify rare or multiple genetic abnormalities and provides a diagnosis in up to 30 percent of these challenging cases.
Research to refine the accuracy of these new tests continues. These tests may not be appropriate for every family. Dr. Wick suggests couples ask their health care provider about genetic testing. She also recommends that all prospective and expectant parents consult with a medical geneticist or genetic counselor, who can help parents choose the right tests and interpret results that reveal inheritable conditions.
"These tests are important for safe family planning before pregnancy as well as for the care of a baby who is found to have a genetic disorder during pregnancy," Dr. Wick says.
Sian can attest to these benefits. When she was pregnant with her older daughter, Quinn, she and her husband, Aaron, had difficulty coordinating prenatal appointments with Aaron's work schedule — plus they needed someone to watch their school-age sons, Easton and Grayson.
"With Finley, it was nice being able to stay home and not always have to find a sitter for appointments," Sian says. "I could check my weight and blood pressure in the comfort of my PJs, knowing that if I had any questions or problems, I could just call and talk to a nurse. And if there was a problem, I could come in. It was always nice to have that comfort." ■
Researchers in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery use technology and other approaches to apply engineering principles to re-imagine the health care experience. Support our efforts today.